I certify that I am fully authorized to execute this one time draft payment on behalf of my company and I authorizeWireless Industry Associationto debit funds from our account as indicated by the above draft form.

<Enter name & title.<Direct phone.<Direct email address - Copy of this page will be sent to you.

A debit draft with above information will appear in your banking system with your Member Name and User I.D. (member number) as a check number. Payee will be "Wireless Industry Association" and "Memo" information will be included.